Safety and Efficacy of Rotational Thrombectomy for Treatment of Arterial Occlusions of the Lower Extremities: A Large Single-Center Retrospective Study

Abstract

Purpose To evaluate the safety and efficacy of rotational thrombectomy (RT) in a large single-center real-world cohort for total vascular occlusions of the lower extremity.

Materials and Methods The clinical records and images of all patients between 2010 and 2020 treated via RT (Rotarex, BD) were assessed. Patient demographics, clinical data, procedural characteristics, and outcome parameters were documented. In total, 397 procedures in 293 patients were included (mean age 69.8 ± 12.0 years; 64.8 % male). Occlusions were acute (47.5 %), subacute and acute-on-chronic (22.2 %), and chronic (30.3 %). The target lesions were the iliac artery (7.1 %), iliac/femoropopliteal (5.0 %), femoropopliteal (59.4 %), femoropopliteal/below-the-knee (27.0 %), below-the-knee (1.5 %), and after bypass surgery (14.9 %). Lesion length was > 20 cm in 61.5 % of cases.

Results Clinically successful revascularization was achieved in 90.4 % of cases. Additional thrombolysis was necessary for 32.0 % of procedures. The arithmetic mean ankle-brachial index increased from 0.33 ± 0.29 to 0.81 ± 0.25 (p < 0.0001). Bypass grafts were less likely to be fully treatable and required additional lysis (p < 0.001). The overall primary patency (no clinically driven target lesion revascularization) was 93.2 %, 88.8 %, 79.1 %, and 72.4 % at 1, 3, 6, and 12 months, respectively. Adverse events occurred in 46.1 % of cases, of which peripheral embolization (22.4 %) was most frequent, requiring interventional treatment in 67.4 % of cases. RT was directly associated with 7.1 % (n = 28) of complications, which consisted of perforations 2.8 %, arteriovenous fistula 1.3 %, and dissections 2.0 %.

Conclusion Rotational thrombectomy is a safe and efficient method for the treatment of occlusions of the arterial circulation of the lower extremity with bypass occlusions having a higher propensity for residual thrombi requiring further lysis therapy.

Key Points: 

• Rotational thrombectomy was safe and efficacious for treating occlusions of the lower extremities.

• Rotational thrombectomy was associated with 7.1 % of complications.

• Distal embolization occurred in 22.4 % of cases with 67.4 % requiring interventional treatment.

• Primary patency was 93.2 %, 88.8 %, 79.1 %, 72.4 % after 1, 3, 6, and 12 months, respectively.

Citation Format

• Artzner C, Martin I, Hefferman G et al. Safety and Efficacy of Rotational Thrombectomy for Treatment of Arterial Occlusions of the Lower Extremities: A Large Single-Center Retrospective Study. Fortschr Röntgenstr 2023; 195: 406 – 415

Zusammenfassung

Hintergrund Evaluierung der Sicherheit und Wirksamkeit der Rotationsthrombektomie (RT) in einer großen realen Kohorte eines einzelnen Zentrums bei totalen Gefäßverschlüssen der unteren Extremitäten.

Material und Methoden Die klinischen Aufzeichnungen und Bilder aller zwischen 2010 und 2020 mittels RT (Rotarex, BD) behandelten Patienten wurden ausgewertet. Es wurden demografische Daten der Patienten, klinische Daten, Verfahrensmerkmale und Ergebnisparameter dokumentiert. Insgesamt wurden 397 Eingriffe bei 293 Patienten eingeschlossen (Durchschnittsalter 69,8 ± 12,0 Jahre; 64,8 % Männer). Die Verschlüsse waren akut (47,5 %), subakut und akut-chronisch (22,2 %) und chronisch (30,3 %). Bei den Zielläsionen handelte es sich um die Arteria iliaca (7,1 %), die Arteria iliaca/femoropoplitea (5,0 %), die Arteria femoropoplitea (59,4 %), die Arteria femoroplitea/unter dem Knie (27,0 %), die Arteria femoroplitea unter dem Knie (1,5 %) und nach einer Bypassoperation (14,9 %). Die Läsionslänge betrug in 61,5 % der Fälle mehr als 20 cm.

Ergebnisse Eine klinisch erfolgreiche Revaskularisierung wurde in 90,4 % der Fälle erreicht. Eine zusätzliche Thrombolyse war in 32,0 % der Fälle erforderlich. Der arithmetische mittlere Knöchel-Arm-Index stieg von 0,33 ± 0,29 auf 0,81 ± 0,25 (p < 0,0001). Bei Bypasstransplantaten war die Wahrscheinlichkeit geringer, dass sie vollständig behandelbar waren und eine zusätzliche Lyse erforderlich wurde (p < 0,001). Die primäre Offenheit (keine klinisch bedingte Zielläsionsrevaskularisation) betrug 93,2 %, 88,8 %, 79,1 % und 72,4 % nach 1, 3, 6 bzw. 12 Monaten. Unerwünschte Ereignisse traten in 46,1 % der Fälle auf, wobei die periphere Embolie (22,4 %) am häufigsten war und in 67,4 % der Fälle eine interventionelle Behandlung erforderlich machte. Die RT stand in direktem Zusammenhang mit 7,1 % (n = 28) der Komplikationen, bei denen es sich um Perforationen (2,8 %), arteriovenöse Fisteln (1,3 %) und Dissektionen (2,0 %) handelte.

Schlussfolgerung Die Rotationsthrombektomie ist eine sichere und effiziente Methode zur Behandlung von Verschlüssen des arteriellen Kreislaufs der unteren Extremität, wobei Bypassverschlüsse eine höhere Neigung zu Restthromben aufweisen, die eine weitere Lysetherapie erfordern.

Wichtige Punkte: 

• Rotationsthrombektomien waren sichere und wirksame Behandlungsmethoden von Verschlüssen der unteren Extremitäten.

• Rotationsthrombektomien waren mit 7,1 % der Komplikationen verbunden.

• 22,4 % der Fälle zeigten distale Embolien, hiervon erforderten 67,4 % eine interventionelle Therapie.

• Die primäre Offenheit betrug 93,2 %/88,8 %/79,1 %/72,4 % nach jeweils 1/3/6/12 Monaten.

Key words

mechanical thrombectomy - obstruction/occlusion - vascular - rotarex - interventional procedures - arteries

Publication History

Received: 05 September 2022

Accepted: 21 September 2022

Article published online:
19 October 2022

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